Form 8453-OL
Form 8453-OL
Form 8453-OL
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Declaration Control Number (DCN)<br />
0 0 – – – 2<br />
<strong>Form</strong><br />
<strong>8453</strong>-<strong>OL</strong><br />
Department of the Treasury<br />
Internal Revenue Service<br />
Use the<br />
IRS label.<br />
Otherwise,<br />
please<br />
print or<br />
type.<br />
Part I<br />
L<br />
A<br />
B<br />
E<br />
L<br />
H<br />
E<br />
R<br />
E<br />
Your first name and initial<br />
U.S. Individual Income Tax Declaration<br />
for an IRS e-file On-Line Return<br />
If a joint return, spouse’s first name and initial<br />
For the year January 1–December 31, 2001<br />
See instructions on back.<br />
Last name<br />
Last name<br />
Home address (number and street). If a P.O. box, see instructions.<br />
City, town or post office, state, and ZIP code<br />
Tax Return Information (Whole dollars only)<br />
IRS Use Only—Do not write or staple in this space.<br />
Apt. no.<br />
OMB No. 1545-1397<br />
Your social security number<br />
Spouse’s social security number<br />
<br />
2001<br />
Important!<br />
You must enter<br />
your SSN(s) above.<br />
Daytime phone number<br />
( )<br />
<br />
1<br />
Adjusted gross income (<strong>Form</strong> 1040, line 33; <strong>Form</strong> 1040A, line 19; <strong>Form</strong> 1040EZ, line 4)<br />
1<br />
2 Total tax (<strong>Form</strong> 1040, line 58; <strong>Form</strong> 1040A, line 36; <strong>Form</strong> 1040EZ, line 11)<br />
2<br />
3 Federal income tax withheld (<strong>Form</strong> 1040, line 59; <strong>Form</strong> 1040A, line 37; <strong>Form</strong> 1040EZ, line 8) 3<br />
4<br />
Refund (<strong>Form</strong> 1040, line 68a; <strong>Form</strong> 1040A, line 43a; <strong>Form</strong> 1040EZ, line 12a)<br />
4<br />
5 Amount you owe (<strong>Form</strong> 1040, line 70; <strong>Form</strong> 1040A, line 45; <strong>Form</strong> 1040EZ, line 13). See instructions 5<br />
Part II<br />
Declaration of Taxpayer<br />
6a<br />
b<br />
I consent that my refund be directly deposited as designated in the electronic portion of my 2001 Federal income<br />
tax return. If I have filed a joint return, this is an irrevocable appointment of the other spouse as an agent to receive<br />
the refund.<br />
I do not want direct deposit of my refund or I am not receiving a refund.<br />
c<br />
I authorize the U.S. Treasury and its designated Financial Agent to initiate an ACH electronic funds withdrawal (direct<br />
debit) entry to the financial institution account indicated in the tax preparation software for payment of my Federal<br />
taxes owed on this return and/or a payment of estimated tax. I further understand that this authorization may apply<br />
to subsequent Federal tax payments that I direct to be debited through the Electronic Federal Tax Payment System<br />
(EFTPS). In order for me to initiate subsequent payments, I request that the IRS send me a personal identification<br />
number (PIN) to access EFTPS. This authorization is to remain in full force and effect until I notify the U.S. Treasury<br />
Financial Agent to terminate the authorization. To revoke a payment, I must contact the U.S. Treasury Financial<br />
Agent at 1-888-353-4537 no later than 2 business days prior to the payment (settlement) date. I also authorize the<br />
financial institutions involved in the processing of the electronic payment of taxes to receive confidential information<br />
necessary to answer inquiries and resolve issues related to the payment.<br />
If I have filed a balance due return, I understand that if the IRS does not receive full and timely payment of my tax liability,<br />
I will remain liable for the tax liability and all applicable interest and penalties. If I have filed a joint Federal and state tax<br />
return and there is an error on my state return, I understand my Federal return will be rejected.<br />
Under penalties of perjury, I declare that the information I have given my intermediate service provider and/or transmitter<br />
and the amounts in Part I above agree with the amounts on the corresponding lines of the electronic portion of my 2001<br />
Federal income tax return. To the best of my knowledge and belief, my return is true, correct, and complete.<br />
Sign<br />
Here Your signature Date<br />
For Paperwork Reduction Act Notice, see back of form.<br />
<br />
Spouse’s signature. If a joint return, both must sign. Date<br />
Cat. No. 15907C <strong>Form</strong> <strong>8453</strong>-<strong>OL</strong> (2001)
<strong>Form</strong> <strong>8453</strong>-<strong>OL</strong> (2001) Page 2<br />
You may be able to file a completely<br />
paperless return! Your tax preparation<br />
software contains information about<br />
using a self-select PIN instead of filing <strong>Form</strong><br />
<strong>8453</strong>-<strong>OL</strong>. Or, you can visit the IRS Web Site<br />
at www.irs.gov.<br />
General Instructions<br />
Purpose of <strong>Form</strong><br />
Use <strong>Form</strong> <strong>8453</strong>-<strong>OL</strong> to:<br />
● Authenticate the electronic portion of your<br />
2001 <strong>Form</strong> 1040, 1040A, or 1040EZ,<br />
● Send any accompanying paper schedules<br />
or statements, and<br />
● Provide your consent to directly deposit<br />
any refund and/or authorize an electronic<br />
funds withdrawal for payment of Federal taxes<br />
owed and/or a payment of estimated tax.<br />
Who Must File<br />
If you are filing a 2001 <strong>Form</strong> 1040, 1040A, or<br />
1040EZ through an intermediate service<br />
provider and/or transmitter, you must file a<br />
signed 2001 <strong>Form</strong> <strong>8453</strong>-<strong>OL</strong> with the IRS. If<br />
you do not, you will not have filed a valid<br />
return for 2001, and we may not allow you to<br />
file electronically next year.<br />
Note: Do not send a copy of your<br />
<strong>Form</strong> 1040, 1040A, or 1040EZ.<br />
When and Where To File<br />
You must mail this form to the IRS on the<br />
next working day after you have received<br />
acknowledgment from your intermediate<br />
service provider and/or transmitter that the<br />
IRS has accepted your electronically filed<br />
return. The address should be included in<br />
your acknowledgment message. If not, mail<br />
<strong>Form</strong> <strong>8453</strong>-<strong>OL</strong> to the IRS at the applicable<br />
address shown in the chart below. If you do<br />
not receive an acknowledgement, you must<br />
contact your intermediate service provider<br />
and/or transmitter.<br />
Line Instructions<br />
Declaration Control Number (DCN). The<br />
DCN is a 14-digit number assigned to your<br />
return by your intermediate service provider<br />
and/or transmitter. It should be included in<br />
your acknowledgment message. Clearly type<br />
or print the DCN in the top left corner of <strong>Form</strong><br />
<strong>8453</strong>-<strong>OL</strong>. The first two digits are always “00”.<br />
The next six digits are the electronic filer<br />
identification number (EFIN). The next five<br />
digits are the batch number and serial<br />
number. The “2” represents the year the<br />
return is filed (2002).<br />
Example. The EFIN is 509325. The batch<br />
number is 000. The serial number is 56. The<br />
DCN is 00-509325-00056-2.<br />
Name and Address. If you received a<br />
peel-off name and address label from the<br />
IRS, put the label in the name area. Cross out<br />
any errors and print the correct information.<br />
Add any missing items, such as your<br />
apartment number. If you did not receive a<br />
label, print or type the information in the<br />
spaces provided.<br />
P.O. Box. Enter your box number only if the<br />
post office does not deliver mail to your home.<br />
Note: The address must match the address<br />
shown on your electronically filed return.<br />
Social Security Number (SSN). Be sure to<br />
enter your SSN in the space provided on<br />
<strong>Form</strong> <strong>8453</strong>-<strong>OL</strong>. If a joint return, list the SSNs<br />
in the same order as the first names.<br />
Part I—Tax Return Information<br />
Line 5. Do not include any payment with<br />
<strong>Form</strong> <strong>8453</strong>-<strong>OL</strong>. The method of payment<br />
depends on whether you check the box on<br />
line 6b or 6c. For details, see the instructions<br />
for Part II.<br />
Part II—Declaration of Taxpayer<br />
Note: You must check all applicable boxes<br />
on line 6.<br />
If there is an amount on line 5 and you<br />
check box 6b and are paying by check or<br />
money order, do not attach your payment to<br />
<strong>Form</strong> <strong>8453</strong>-<strong>OL</strong>. Instead, mail it by<br />
April 15, 2002, with <strong>Form</strong> 1040-V to the IRS<br />
at the applicable address shown on that form.<br />
If you do not have a <strong>Form</strong> 1040-V, you may<br />
be able to get it from your intermediate<br />
service provider and/or transmitter. You can<br />
also see your tax return instruction booklet for<br />
other ways to get forms, or visit the IRS Web<br />
Site at www.irs.gov.<br />
If you check box 6c, you must ensure that<br />
the following information relating to the<br />
financial institution account is provided in the<br />
tax preparation software.<br />
● Routing number.<br />
● Account number.<br />
● Type of account (checking or savings).<br />
● Debit amount.<br />
● Debit date (date you want the debit to<br />
occur).<br />
Your electronically transmitted return will<br />
not be considered complete, and therefore<br />
filed, unless and until the IRS receives your<br />
signed <strong>Form</strong> <strong>8453</strong>-<strong>OL</strong>. If a joint return, your<br />
spouse must also sign.<br />
Your signature allows the IRS to disclose to<br />
your intermediate service provider and/or<br />
transmitter the reason(s) for a delay in<br />
processing your return or refund. If you are<br />
applying for a refund anticipation loan or<br />
similar product, your signature also allows the<br />
IRS to advise your intermediate service<br />
provider and/or transmitter if a refund offset<br />
may occur.<br />
Refunds. Your refund should be issued within<br />
3 weeks after the IRS has accepted your<br />
return. However, some refunds may be<br />
delayed because of compliance reviews to<br />
ensure that returns are accurate. Refund<br />
information is available on TeleTax. Call<br />
1-800-829-4477.<br />
IF you live in . . . THEN mail <strong>Form</strong> <strong>8453</strong>-<strong>OL</strong> to this address . . .<br />
Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New<br />
Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and all<br />
APO and FPO addresses (except Asian/Pacific)<br />
Illinois, Iowa, Kansas, Minnesota, Missouri, New Mexico, Oklahoma, Texas, Wisconsin<br />
Florida, Indiana, Kentucky, Michigan, Ohio, South Carolina, West Virginia<br />
Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, Tennessee<br />
Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nebraska, Nevada, North<br />
Dakota, Oregon, South Dakota, Utah, Washington, Wyoming, and all Asian/Pacific APO and<br />
FPO addresses<br />
Receipt and Control Branch<br />
Shipping and Receiving<br />
310 Lowell Street<br />
Andover, MA 05501<br />
Receipt and Control Branch<br />
Shipping and Receiving<br />
P.O. Box 1231<br />
Austin, TX 78767-1231<br />
Stop 2701<br />
Cincinnati, OH 45999<br />
P.O. Box 1898<br />
Attn: <strong>8453</strong>-<strong>OL</strong><br />
Memphis, TN 38101<br />
Stop 6052<br />
1160 West 1200 South<br />
Ogden, UT 84201<br />
Paperwork Reduction Act Notice. We ask for<br />
the information on this form to carry out the<br />
Internal Revenue laws of the United States. You<br />
are required to give us the information. We need<br />
it to ensure that you are complying with these<br />
laws and to allow us to figure and collect the<br />
right amount of tax.<br />
You are not required to provide the<br />
information requested on a form that is subject<br />
to the Paperwork Reduction Act<br />
unless the form displays a valid OMB control<br />
number. Books or records relating to a form or<br />
its instructions must be retained as long as their<br />
contents may become material in the<br />
administration of any Internal Revenue law.<br />
Generally, tax returns and return information are<br />
confidential, as required by Internal Revenue<br />
Code section 6103.<br />
The time needed to complete and file this<br />
form will vary depending on individual<br />
circumstances. The estimated average time<br />
is 15 minutes. If you have comments concerning<br />
the accuracy of this time estimate or<br />
suggestions for making this form simpler, we<br />
would be happy to hear from you. You can write<br />
to the Tax <strong>Form</strong>s Committee, Western Area<br />
Distribution Center, Rancho Cordova, CA<br />
95743-0001. Do not send the form to this<br />
address. Instead, see When and Where To File<br />
on this page.